This document discusses various types of spinal tumors, including their location, characteristics, and MRI appearances. It covers primary spinal tumors such as schwannomas, neurofibromas, meningiomas, ependymomas, astrocytomas, and hemangioblastomas. It describes these tumors' demographics, symptoms, classification as interdural exteramedullary or interdural intramedullary, and features on T1-, T2-, and contrast-enhanced MRI sequences. Rare tumors like lipomas, paragangliomas, and subependymomas are also outlined briefly.

1. Spinal Tumors
Chapter 43
Page 509-514

2. Introductions
 The advent of MRI has led to widespread recognition of
interadual lesion.
 It can be difficult to distinguish as interdural lesion from
transverse myelitis, demyelinating condition or other lesion
not suitable for surgery.
 A carful physical exam can isolate the level of involvement
along the spinal cord.
 The risk of surgical damage to critically important regions
surrounding a lesion must be weighted against risks
associated with nonsurgical.

3.  Primary CNS tumor are more common intracranially,
2% to 4% such tumor occur in the spine.
 Primary CNS tumor of the spine is classified as;
- Exteradural
- Interadural exteramedullary
- Interdural interamedullary.
• an exteradural tumor typically represents a metastasis or
lymphoma.
Primary Spinal Tumors

5. Interadural Exteramedullary Tumor
 Its account for 60% to 70% of all primary spinal cord
tumors.
 Most of this tumor are nerve sheet tumor or
meningioma.
 Patient usually have symptoms related to cord
compression, including local or radicular pain.
 Patient often report deep seated pain in the back.

6. Schwannoma
 Is a type of nerve sheath tumor.
 Usually is benign, although malignant subtype is exist.
 Commonly originate from dorsal nerve root.
 The peak incidence is during the forth and fifth decades
of life.
 They occur equally among male and female.
 The tumor may be associated with neurofibromatosis
type II

7. MRI Appearance
 On MRI, a schwannoma appears as a lesion arising from
the dorsal root.
 Some time as dumbbell lesion with both interadural and
exteradural components.
 T1 weighted MRI image show isointensity
 T2-weighted image show marked hyperintinsity.
 The contrast enhancement is variable

10. Other Characteristics
 Tumor that have existed for long period of time can erode
the neural foramina and scalloping of posterior vertebral
body.
 Schwannoma occur: 31% in cervical spine 24% in cauda
equina, 22% in thoracic spine, 16%upper cervical spine,
and 7%. conus medullaris
 It can be difficult to distinguish a schwannoma from a
neufibroma.

11. Neurofibroma
 It originate in the peripheral nerve and tend to favor the
ventral root.
 They are classified as general of plexiform.
 A solitary general neurofibroma is a discrete well-
circumscribed lesion with a fusiform or globular
appearance.
 The peak incidence is during the fourth and fifth decades of
life.
 Equal distribution among men and women.

12.  The presence of multiple neurofibromas can suggest
neurofibromatosis.
 50% of patients with neurofibromatossi type I have a
malignant peripheral nerve sheath tumor
 Like schwannoma, a neurofibroma appears as a well-
circumscribed, rounded or fusiform lesion that may be
dumbbell shaped.
 The imaging characteristics also are similar
 Isointensity on T1W-MRI and marked hyper intensity on T2
w-MRI.
 With intense contrast enhancement.

13. T1: hypointense
T2: hyperintense
T1 C+ (Gd): heterogenous
enhancement

14. Meningioma
 Is a dura-based benign tumor that accounts for 25% of all
primary spinal cord tumors.
 More than 80% of spinal meningiomas are diagnosed in
women
 Most tumor occur in thoracic spine.
 In men, meningiomas occur with equal in the cervical and
thoracic.
 The peak incidence of these tumors is during the fifth and
sixth decade of life.
 94% of meningiomas are interadural and 6% are
exteradural.

15. MRI Appearances
 It appear as a well circumscribed, dura based lesion.
 Tumor is isointense or hypointencse on T1w-MRI
 On T2 w-MRI slightly hyperintense.
 Homogenous intense in contras enhancement.
 Calcification sometimes are present.
 In contrast with neurofibromas meningiomsa usually are
entirely intradural or exteradural.
 Multiple meningiomas are particularly associated with
neurofibromatosis type II

17. Meningeal
hemangiopericytoma Is an exteremely rare tumor with only a few incidences.
 Malignant feature are more common than in other types of
intradural exteramedullary tumor.
 The lesion has lobular appearance on MRI
 Heterogeneity on T1 and T2 MRI angiogram reveals
corkscrew vessels with an associated tumor blush.

18. Dermoid and Epidermoid
Cysts They arise from abnormal heterotopic presence of
ectodermal cells in the neural tube during embryogenic
development.
 Approximately 40% of epidermoid cysts in the spine are a
late complication of lumbar puncture in which tissue was
implanted in the thecal sac.
 These lesions usually are found in the lumbosacral spine,
although they also can appear in the thoracic region.

19.  Epidermoid cyst typically appear during the fourth decade
of life.
 Dermoid appear during the third decade.
 If the lesion rupture chemical meningitis can ensue.
 An epidermoid cyst can be difficult to see on MRI because it
consistency is similar to that of cerebrospinal fluid.
 Diffusion-weighted MRI can be useful for distinguishing
an epidermoid cyst from an arachnoid cyst.
 Dermoid cyst contain solid cholesterol, and their signal
intensities can be similar to those of fat.

20. Lipoma
 Intradural extramedullary lipomas are congenital.
 The typical regions of involvement are the lower thoracic
and lumbosacral spine.
 A lipoma in the region of the cauda equina can cause
tethered cord syndrome.
 On MRI Lipoma is hyperintence on T1 and hypointence on
T2

21. T1: hyperintense T2: hypointense
fat-suppressed
sequences:

22. Paraganglioma
 Is a nonsecrating tumor derived form paraganglion cell of
the autonomic nervous system.
 These tumor are considered benign.
 The mean age of patinas is 48 years.
 More men than women are affected.
 Typically involves the conus medullaris, cauda equina or
filum terminale.

24. MRI Appearance
 The signal is hypointense or isointense on T1-weighted MRI
and heterogeneous on T2
 Hemosiderin deposits on the periphery of the tumor can
appear as a rim of T2-weighted or gradient echo
hypointensity.
 The infusion of contrast can produce the classic salt-and-
pepper appearance.

25. Intradural Inramedullary
Tumors Intramedullary tumors represent 20% to 30% of all
intradural tumors in adults and 50% of intrdural tumors in
children.
 More than 80% of intramedullary tumors are classified as
gliomas.
 30% to 40% of intramedullary tumors are classified as
astrocytoma's.
 60% to 70% are classified as ependymomas.
 Astrocytoma are more common in children and
ependymomas are more common in adults.

26.  Hemangioblastoma accounts for 3% to 8% of primary
intramedullary tumors
 This tumor is associated with von Hippel-Lindau disease in
15% to 20% of patients.
 Only 2% of intramedullary tumors are of metastatic origin.
 The symptoms of the tumor vary with its location.
 Local or radicular pain is common.
 Motor deficits occur in 50% to 69%. Sphincter dysfunction
occur in 64% to 65%
 Sphincter dysfunction is the initial symptoms in 14% to
38%

27. Ependymoma
 Is the most common intramedullary tumor.
 Typically classified as cellular or myxopapillary.
 Myxopapillary ependymoma accounts for approximately
40% to 50% of spine ependymomas.
 Clear-cell, papillary, anaplastic, and mixed variant subtypes
also exist.

30.  The incidence of cellular ependymoma peaks during the
fourth and fifth decades of life.
 Cellular ependymoma represents 40% to 60% of all
intramedullary tumors in adult and 16% to 23% in children.
 Myxopapillary and cellular ependymoma are histologically
distinct.
 Cellular ependymoma appear as a focal enlargement of the
spinal cord.
 The cervical spine affected in 42% of patients
 On MRI is diffuse heterogeneous contrast enhancement
with isointensity or hypointensity on T1 and hyperintesity
on T2

31. Astrocytoma
 75% of astrocytomas are benign.
 They typically occur during the third decade of life.
 No preference for men or women.
 In children represents as many as 80% to 90% of
intramedullary tumors.

32. MRI Appearances
 This tumor have fusiform appearance on MRI with
irregular margins.
 Intratumoral, caudal or rostral cysts can evolve into
syringomyelia.
 The appearance is hypointense to isointense on T1
 On T2 is hyperintense, with variable contrast enhancement.
 In high grade lesion, there is more prominent enhancement
intratumoral cysts can appear and surrounding edema and
necrosis become more obvious.
 The tumor is more common in the cervical spine of adults

34. Hemangioblastoma
 Is a benign vascular tumor.
 10% to 25% are associated with von Hippel-Lindau disease.
 Sporadic tumors occur predominantly in men typically
during the fourth decade of life.
 The tumor favor the dorsal location and thus tends to affect
sensation.
 Most of this lesion are solitary and are found in cervical of
thoracic spine.

35. MRI Appearances
 MRI reveals a homogeneously enhancing nodule
accompanied by a cyst and sometimes by peritumoral
edema or syringomyelia.
 Small lesion appears isointense on T1and hyperintense on
T2
 Large lesion appears isointense to hypointese with T1 and
hetrogeneous with T2
 Heterogeneous contrast enhancement is seen within the
nodule.

37. Sub Ependymoma
 Fewer than 50 incidence of subependymoma have been
reported.
 Predominantly in men in their fourth or fifth decade of life.
 Is located in cervical spine and less commonly in the
thoracic spine.
 A subependymoma mimics a spine ependymoma on MRI

38. Other Interadural Intermedullary
Tumors
 Oligodendrogalioma 2% located on spine.
 Ganglioglima
 Lymphoma
 Germinoma
 Melanoma
 Lipoma is a congenital lesion
 Teratoma
 Intamedulary metastasis
References: 1- Orthopedic knowledge update spine chapter 43
2- radiopaedia.org/articles/spinal-nerve-sheath-tumours.
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